Contraceptive Use in a Changing Service Environment: Evidence from the First Year of Indonesia

Abstract:
Since the 1970s many developing countries have launched large-scale efforts to provide couples with family planning services. The nature of these programs and the rhetoric that accompanies them has changed over time, reflecting available resources, perceptions of the most relevant population and program issues, levels and emphasis of overseas assistance, innovations in contraceptive technology, and research findings on program effectiveness. In some countries the private sector has emerged to complement or substitute for the government as an important source of contraceptive services. Two important research topics on the links between family planning use and supply-side factors are how contraceptive use patterns respond to the price of contraceptive services and to the quality and availability of services (see for example Jain, 1989; Mensch et al., 1996; Koenig et al., 1997; Mroz et al., 1999). Analysis of these topics is limited by the lack of available data on characteristics of the contraceptive service environment linked to women's choices regarding use (Mensch et al., 1996). We address these topics, using unusual longitudinal data from providers and individuals collected in Indonesia (as part of the Indonesia Family Life Survey) before and during the economic crisis of the late 1990s. Though the crisis affected many Asian countries, Indonesia has been the country most hard hit (Stalker, 2000). Because the data straddle a period of economic downturn, the service environment at the second observation (1998) differs drastically from the service environment at the first observation (1997). In Indonesia most health and family planning supplies are imported, so a large-scale currency depreciation has major implications for services (UNFPA 1998). These changes give us purchase on identifying the relationship between the service environment and patterns on contraceptive use. We first consider the question from the user's perspective by documenting for each year levels of use, reasons for non-use, and method mix. We then consider patterns of use by various background characteristics of a user and her household. We also examine choice of providers and satisfaction with source of supply in 1998. Next we turn to the supply side. Because we have data from public, private, and community providers of contraceptive services in both years, we are able to consider, from the perspective of providers, how the quality and price of services changed during the first year of the crisis. To bring these two perspectives together, we construct community-level measures of the family planning service environment before and during the economic crisis from the information from the provider. We then use multinomial logistic regression methods to relate these measures to individual women's choice of provider, controlling for individual and household characteristics.

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